| NPI | 1245290220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2628) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2011-06-03 |